Reporting of Tobacco Use and Health Outcomes Among Transgender and Gender-Expansive People in Gender-Affirming Hormone Therapy Research: 1980-2024.

A total of 107 studies published from 1980 to 2024 mentioned tobacco and gender-affirming hormone therapy (GAHT) for transgender/gender-expansive (TGE) patients.

• Searches were conducted in PubMed, Embase, PsycInfo, Google Scholar, and Mednar.
• The protocol was registered in Prospero (CRD42023416390).
• Studies spanned a 44-year publication period from 1980 to 2024.
• Most studies focused on adults (80.4%).

Patient samples across the 107 studies varied in gender identity composition.

• Feminine/transfeminine patients were the focus in 29.9% of studies.
• Masculine/transmasculine patients were the focus in 26.2% of studies.
• 'Both'/combinations were represented in 43.0% of studies.

The vast majority of studies reported smoking prevalence, with wide variation in rates across studies.

• 96.3% of studies reported smoking prevalence.
• Reported smoking prevalence ranged from 4.2% to 73.0% across studies.
• This wide range indicates substantial variability in how tobacco use was assessed and reported.

Only a minority of studies found a significantly increased risk of adverse health events associated with tobacco use during GAHT.

• 43 studies (40.2%) explored patient outcomes as they related to GAHT and tobacco use.
• Only 5 studies (4.7%) found significantly increased risk of adverse health events for TGE people receiving GAHT with tobacco use relative to no tobacco use.
• This represents only 11.6% of the 43 studies that explored outcomes related to GAHT and tobacco use.

Tobacco cessation was largely absent from the literature on GAHT and TGE people.

• Tobacco cessation was not mentioned in 79.4% of studies.
• No studies reported offering cessation assistance to TGE patients pursuing GAHT.
• This gap exists despite TGE people using tobacco at high rates and being frequently advised not to use tobacco during GAHT.

TGE people who use tobacco are frequently advised not to use tobacco during GAHT due to increased risk of negative health events.

• The increased risk of negative health events associated with tobacco use during GAHT is the basis for clinical recommendations against tobacco use.
• However, the systematic review found limited empirical evidence in the literature to substantiate associations between tobacco use and GAHT-related health outcomes.
• The disparity between clinical advice and empirical evidence highlights a gap in the literature.

Accurate tobacco use assessment is identified as essential for discerning associations with GAHT-related outcomes.

• The review found that accurate tobacco assessment is essential to discern associations with GAHT-related outcomes.
• All healthcare professionals should assess and record tobacco use accurately for TGE patients.
• The authors recommend that future studies exploring the association between tobacco use and GAHT-related outcomes include accurate tobacco use assessment and follow-up.